成年人減重與預防增重的適當介入策
略
2001 ACSM Position Stand
台灣師大 方進隆教授
摘要


In excess of 55% of adults in the
United States are classified as either
overweight (BMI= 25-29.9 kg/m.m) or
obese (BMI greater than 30 kg/m.m).
超過55% 的美國成年人體重不是過重就
是肥胖.
摘要
重視這明顯的公共健康問題

To address this significant public health
problem, the ACSM recommends that the
combination of reductions in energy intake
and increase in energy expenditure, through
structured exercise and other forms of
physical activity,be a component of weight
loss intervention program.
美國運動醫學會建議


結合減少能量攝取和增加能量消耗的方
式來減重.
透過結構式或其他型態的身體活動, 讓這
些活動成為介入計劃的一部份.
減少能量攝取500-1000
kcal/day 脂肪攝取< 30%


An energy deficit of 500-1000 kcal/day
achieved through reduction in total
energy intake is recommended.
Moreover, it appears that reduction
dietary fat intake to < 30% of total
energy intake may facilitate weight loss
by reducing total energy intake.
摘要

Although there may be advantages to
modifying protein and carbohydrate
intake, the optimal doses of these
macro-nutrients for weight loss have
not been determined.
每週中度運動時間至少150分
鐘, 有明顯健康效果.


Significant health benefits can be recognized
with participation in minimum of 150 min of
moderate intensity exercise per week, and
overweight and obese adults should
progressively increase to this initial exercise
goal.
體重過重者與肥胖者開始運動時要達到這個目
標.
每週能逐漸運動至200-300分
鐘, 長期減重效果更佳

However, there may be advantages to
progressively increasing exercise to
200-300 min of exercise per week, as
recent scientific evidence indicates that
this level of exercise facilitates the longterm maintenance of weight loss.
重量訓練可增加肌力與身體功能, 但可能無
法減低能量攝取減少所導致的肌肉質量流
失.

The addition of resistance exercise to a
weight loss intervention will increase
strength and function but may not
attenuate the loss of fat-free mass
typically observed with reductions in
total energy intake and loss of body
weight.
藥物治療在醫療需要時才使用,
此法配合食物和運動行為改變更有效

When medically indicated,
pharmacotherapy may be used for
weight loss, but pharmacotherapy
appears to be most effective when used
in combination with modification of
both eating and exercise behaviors.
摘要


The ACSM recommends that the
strategies outlined in this position paper
be incorporated into interventions
targeting weight loss and the
prevention of weight regain for adults.
本聲明所列的策略融入介入計劃時, 重點
在於成年人的減重及預防減重後體重再
增加的現象.
簡介


Obesity has been shown to be associated
with chronic diseases and health
conditionings such as heart disease, diabetes,
cancer, hyperlipidemia, hypertension, and
hyperinsulinemia.
The risk associated with obesity is concerning
because it estimated that about 55-60 % of
adults over the age of 18 have a BMI>25,
with about 22% having BMI> 30.
introduction


Moreover, the prevalence of individuals
with a BMI>25 in the USA increase
from 44 to 52 % from the late 1970s to
early 1990s, with the prevalence of
individuals with BMI >30 increasing
from 13 to 21%.
再最近二十年間, 體重過重與肥胖者的比
率皆增加不少.
美國每年花一千億美金來治療與肥胖
有關的疾病, 約健保費用的5-10%

The increased prevalence of overweight
and obesity has resulted in an estimate
$100 billion spent to treat obesityrelated condition annually, with the
direct costs of obesity being about 510% of the health care dollars spent
annually.
針對肥胖者減重, 而是針對運動
員, 小孩或是青少年.

For the purpose of this position stand,
recommendations will be limited to
weight loss in overweight and obese
adults, and will not address weight loss
related to sport and athletic
performance, nor weight loss
interventions specifically targeting
children and adolescents.
體重過重與肥胖的定義

Within this position stand, overweight is
define as a BMI equal to 25-29.9
kg/m.m, with obesity defined as a BMI
>= 30 kg/m.m.
Identifying adults for whom
weight loss is recommended


Studies have consistently shown a
linear or J-shaped relationship between
BMI and relative risk of morbidity
and/or mortality.
BMI與疾病或死亡率的關係形成J 形.
Magnitude of weight loss
recommendation


An initial weight loss goal should be to
decrease body weight by 5-10% and to
sustain this magnitude of weight loss
long-term.
開始減重的目標應減少體重5-10% ,而維
持一段長的時間.
Magnitude of weight loss
recommendation

However, even though a weight loss of <
10% is associated with initial improvements
in risk factors, the maintenance of a weight
loss that is < 10% may not result in the
improvements in these risk factors being
sustained long-term. Therefore, long-term
health benefits may be maximized with
sustained weight loss of >= 10% of initial
body weight.
最後的減重還是要大於10%

雖然開始減重在10% 以內, 會與改善健
康之危險因素有關. 但長時間維持在減重
10% 以內, 可能無法導致危險因素的改
善. 因此, 為維持長期健康的好處, 減重
要超過最初體重的10% 以上.
飲食建議 每天減少能量攝取
500-1000 kcal


The absolute energy intake should be
adjusted based on body weight to elicit
an energy deficit 500-1000 kcal/d. With
this deficit, a minimum weight loss of
0.5-0.9 kg per week would be realistic.
這樣每週至少可以減重0.5-0.9 公斤. 這
是很實際的.
快速減重並無證據指出其長期
減重效果比保守的減重好

Currently, there is no evidence that a
faster rate or greater magnitude of
initial loss will improve long-term weight
loss outcomes compared with more
conservative approaches.
辦別需要減重的成年 腰圍男性
大於102公分 女性大於 88公分

It has been shown that a girth
measurement of the abdomen provides
an adequate clinical health screening
procedures. Thus, weight loss is
recommended when the girth of
abdomen is >= 102 cm in men and >=
88 in women.
非常低能量食物


過低的能量攝取初期產生較大的減重, 並
不表示能維持長期的減重效果
Excessively low levels of energy intake
to produce a greater magnitude of
initial weight loss do not necessarily
translate into better maintenance of
weight loss long-term.
大部分人的減重並不需要採用
非常低能量的食物


Therefore, use of VLCD may not be
recommended for weight loss in most
individuals, but use of a VLCD may be
appropriate when medically indicated.
有醫療需要時, 才採用非常低能量的食物.
運動建議
Exercise recommendation

Despite the importance of exercise,
there is little evidence that suggests
that exercise alone produce magnitudes
of weight loss that are similar to what
can be achieved with dietary
modification. 即使運動很重要, 但是很少
有證據指出只有靠運動, 或是只藉飲食攝
取所減少的重量是否相同.
其他因素皆控制, 運動能夠明顯
減少體重


It was shown that when the energy
deficit is held constant and other factors
that affect energy balance are
controlled, exercise can induce
significant weight loss.
減少能量攝取和其他影響的因素都維持
一致, 運動能夠明顯減少體重.
減重的運動處方Exercise prescription
considerations for weight loss


減重的運動要考慮有關的運動量, 強度和
方式.
It is important to consider the amount,
intensity, and type of exercise that
should be recommended for weight loss.
減重初期與末期的運動計劃不
同

The recommended level of exercise for
sedentary adults during the initial phase
of weight loss should be differentiated
from the amount of exercise that can be
achieved at later stages in the weight
loss process.
減重的運動處方


The amount of exercise necessary to
improve fitness may be different than
the amount of exercise necessary for
successful long-term weight loss.
用以改善體適能的運動量, 和用以減重的
運動量會不相同.
運動時間與減重
Exercise duration and weight loss


The current public health
recommendation for physical activity is
for individuals to participate in at least
30 min of moderate intensity physical
activity on most, preferably all, days of
the week.
現在公共健康的建議是每天從事中度的
運動三十分鐘, 每週最好每天皆能運動.
運動時間與減重 Exercise
duration and weight loss


This recommendation has typically been
interpreted as a minimum of 150 min of
physical activity per week (5 d, 30
min/d) and is based primarily on the
effects of exercise on cardiovascular
disease and other chronic conditions.
每週最少150 分 (5 天,每天30分)主要是
為改善心肺疾病與其他慢性疾病
運動時間與減重


However, that levels of exercise greater
than this minimum recommended
amount may be important for
maintaining weight loss long-term.
但是, 超過每週至少150 分的運動量是維
持長期減重很重要的因素.
運動強度與體重控制Exercise
intensity and weight loss


It appears that a sufficient amount of
moderate-intensity (55-69% MHR)
exercise can be beneficial for
management of body weight.
55-69%最大心跳率的中度運動如有足夠
的運動量, 就有助於減重.
運動強度與體重控制


少數的研究指出需要較高強度(> 70%
MHR)的運動方式來控制體重.
with limited published scientific
evidence from randomized trials to
support the necessity of more vigorous
(> 70% MHR) forms of exercise for
management of body weight long-term.
間斷性運動與體重控制Intermittent
exercise and weight loss


The use of intermittent exercise may be
advantageous for individuals that dislike
continuous exercise or perceived
barriers to continuous exercise.
間斷性運動對一些不喜歡連續運動的人
有好處.
生活方式與減重Lifestyle
activity and weight loss


Lifestyle activity appears to be a
promising alternative to structured
forms of exercise.
除了結構性(規律性)的運動, 融入生活方
式的運動可能是一種很好減重的替代方
法.
生活方式與減重

Further research is necessary to
examine the effectiveness of specific
forms of lifestyle physical activity to
change both body weight,
cardiorespiratory fitness, and risk
factors that may be common in
overweight adults. 有必要去研究特殊形
式的生活方式運動對於改變減重, 心肺功
能與危險因素的影響.
重量訓練與減重Resistance
exercise and weight loss

Although resistance exercise may
improve muscular strength in
overweight adults, there is no scientific
evidence to suggest that resistance
exercise is superior to more commonly
used forms of endurance exercise for
weight loss. 沒有研究證據指出重量訓練
比其他有氧運動的減重果好.
Pharmacological weight loss
treatment 減重的藥物處理

All current guidelines consider
pharmacotherapy to be an adjunct to
lifestyle modification intervention and
limit their use to patients with BMI> 30,
or a BMI > 27 with additional
comorbidities. 現代指導原則是, 藥物治
療配合生活方式改變介入只限定在BMI>
30, 或 BMI > 27而有疾病的人.
減重的藥物處理


There are only two prescription drugs
that are approved in the united states
by FDA.
Siburramine and orlistat 這兩種藥是美
國食物藥物管理局核准的.
sibutramine


是抑制serotonin and noradrenaline再吸
收的藥物(reuptake inhibitor.)
Adverse events: 不良作用: 增加平均動
脈壓, 心舒壓與安靜心跳率.
sibutramine


有些人使用要小心, 高血壓,或血壓控制
不好的人不能使用.
Use with caution in patients with high
BP and should not used uncontrolled or
poorly controlled BP.
Orlistat 胃腸道解脂脢抑制劑,
減少身體對脂肪的吸收.


Lipase inhibitor that works in the
gastrointestinal tract to reduce the
body’s absorption of fat.
不良作用Adverse events: 改變排便的習
慣changes in bowel habits, 脂肪瀉痢
steatorrhea, and fecal urgence等.
Orlistat


Reduces the absorption of fat-soluable
vitamines (A,D,E,K). Supplement of fatsoluble vitamin.
減少脂溶性維生素(A,D,E,K)的吸收, 要補
充脂溶性維生素.
總結 Summary of weight loss
recommendations for the lay public


It have been shown that 29 % of men
and 44% of women are attempting to
lose weight.
有29 %的男性與 44%的女性嘗試減重.
總結 Summary

但只有 22%的男性與19% 的女性減少能
量攝取和每週運動超過150分鐘.
Summary雖然適度的改變能量攝
取與運動對大部分的人是安全的


1, although moderate changes in
energy intake and exercise are typically
safe for most individuals consult with
their personal physician or other trained
health care professional before
engaging in a weight loss program.
在減重計劃前請教醫師或其他專業人員.
Summary


2, It is recommended that individuals
with a BMI > 25 consider engaging in
weight loss efforts to reduce their body
weight.
BMI > 25的人要減重.
Summary


3, It is recommended that individuals
undertaking non-medically supervised
weight loss initiatives reduce energy
intake by 500-1000 kcal/d to elicit a
weight loss of about 0.5-0.9 kg/week.
以非醫療監控的減重方式, 每天減少5001000 kcal的能量攝取, 每週減重 0.5-0.9
kg.
脂肪攝取低於總能量攝取的
30%

In addition to reducing total energy
intake, it is recommended that dietary
fat intake be reduced to <30% of total
energy intake.
Summary


4, it is recommended that individuals
seeking weight loss include exercise as
a key component to their weight loss
program.
要減重的人要將運動當為減重的一個主
要方式.
體重過重與肥胖者要逐漸活動到
每週至少從事中度運動150分.


It is recommended that overweight and
obese adults progress to a minimum of
150 min of moderate intensity exercise
per week and, when possible, progress
to > 200 min of moderate exercise per
week.
如可能, 要增加到每週至少運動200分.
Summary 要用食物補充劑或是減重物
品, 需在醫師或專業人的指導下使用.

5, it is recommended that individuals
interested in using dietary supplements
or weight loss enhancing agents do so
only under the guidance of their
personal physician or other trained
health care providers.
Macronutrient composition

The currently available scientific
evidence appears to indicate that
macronutrient content (such as high fat,
high protein, and high-and lowcarbohydrate diets)of the diet will affect
body weight only when there is also a
reduction in total energy intake.
大量營養素

大量營養素的組成(像高脂肪,高蛋白,高
或低太水化合物食物)如會影響體重, 只
有在減低其能量攝取時才會產生.